Impact of Shared Decision-Making on Opioid Prescribing Among Patients with Chronic Pain: A Retrospective Cohort Study

This study measured whether SDM affects opioid prescribing frequency for chronic low back pain. A retrospective cohort study involving 1478 participants was conducted within a national pain research registry. The patient participation and patient orientation (PPPO) scale of the Communication Behavior Questionnaire was used to measure SDM, including classification of greater SDM (PPPO scale score≥80) or lesser SDM (PPPO scale score<80). Opioid prescribing frequency was measured at quarterly intervals from enrollment through 12 months. Baseline and longitudinal covariates were collected to adjust for potential confounding using generalized estimating equations. The mean age of participants was 53.1 (SD, 13.2) years and 1098 (74.3%) were female. A total of 473 (32.0%) participants were prescribed opioids at baseline. Participants completed 5968 encounters wherein multivariable analyses demonstrated that PPPO scale scores were associated with more frequent opioid prescribing (β=0.013; 95% CI, 0.005 to 0.021; P<0.001). Greater SDM was associated with more frequent opioid prescribing than lesser SDM (β=0.441; 95% CI, 0.160 to 0.722; P=0.002). Opioids were prescribed in 34.3% vs. 25.2% of encounters with greater vs. lesser SDM (OR, 1.55; 95% CI, 1.17-2.06). SDM remained associated with more frequent opioid prescribing in a series of sensitivity analyses. Although SDM is desirable in chronic pain management, complex issues and challenging patient conversations may arise dur...

Source: Pain Physician - April 14, 2024 Category: Anesthesiology Authors: John C Licciardone Braden Van Alfen Michaela N Digilio Rylan Fowers Bassam Ballout Yasser Bibi Subhash Aryal Source Type: research